CurrentAnthemPolicy C-06005

Modifiers 80, 81, 82, and AS: Assistant at Surgery

This reimbursement policy governs Anthem Blue Cross Medi-Cal Managed Care payment and coding rules for assistant-at-surgery modifiers (80, 81, 82, AS) and applies to claims submitted for covered members in California.

Policy Summary

PayerAnthem

PolicyModifiers 80, 81, 82, and AS: Assistant at Surgery

Policy CodePolicy C-06005

Change TypeReimbursement percentage revision

Effective DateDec 19, 2023

Next Review Date

Key ActionServices must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis; improper billing may result in denial or recoupment.

SourceLink

POLICY UPDATE CHANGES

Updated Modifier 80 reimbursement from 20% to 16% and Modifier 81 from 20% to 10%.

16%Modifier 80 reimbursement

10%Modifier 81 reimbursement

20%Modifier 82 / AS reimbursement

1Allowed assistants

CaliforniaState applicability

Assistant-at-Surgery Coverage Criteria

Conditions under which assistant-at-surgery reimbursement is allowed or denied:

Anthem allows reimbursement for one assistant surgeon when eligible procedures are billed with Modifier 80 as applicable unless otherwise noted by provider, state, federal, or CMS contracts and/or requirements.

If an applicable modifier is not billed appropriately, the procedure may be denied.

Anthem does not allow reimbursement for Modifiers 81, 82 or AS.

When multiple procedures are performed where only some procedures are eligible for assistant-at-surgery reimbursement, only assistant-at-surgery services for the eligible procedures will be considered for reimbursement; the same multiple-procedure fee reductions and clinical edits apply to both the assistant at surgery and the primary surgeon.

Policy Summary

PayerAnthem

PolicyModifiers 80, 81, 82, and AS: Assistant at Surgery

Policy CodePolicy C-06005

Change TypeReimbursement percentage revision

Effective DateDec 19, 2023

Next Review Date

Key ActionServices must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis; improper billing may result in denial or recoupment.

SourceLink

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Modifiers, Reimbursement, and Quantity Limits

Assistant-at-surgery ModifiersModifierCovered

80	Denotes an assistant at surgery providing full assistance to the primary surgeon; reimbursement is based on 16% of the allowable fee for the primary surgeon.
81	Denotes an assistant at surgery providing minimal assistance to the primary surgeon; reimbursement is based on 10% of the allowable fee for the primary surgeon.
82	Denotes an assistant at surgery when a qualified resident surgeon is not available to assist the primary surgeon; reimbursement is based on 20% of the allowable fee for the primary surgeon.
AS	Denotes an assistant at surgery who is a non-physician (physician assistant, nurse practitioner or clinical nurse specialist); reimbursement is based on 20% of the allowable fee for the primary surgeon.

Number of reimbursed assistants

Number of reimbursed assistantsAnthem allows reimbursement for one assistant surgeon when eligible procedures are billed with Modifier 80 as applicable.

RestrictionAnthem does not allow reimbursement for Modifiers 81, 82 or AS unless otherwise noted by provider, state, federal, or CMS contracts and/or requirements.

Multiple proceduresWhen multiple procedures are performed, only assistant services for eligible procedures will be considered for reimbursement; multiple-procedure fee reductions and clinical edits apply to both assistant and primary surgeon.

Billing alignmentAssistant should not report procedure codes different from the primary surgeon, except when the primary surgeon bills a global code; then the assistant bills the specific surgery code with the appropriate modifier.

Authorization, Billing, and Compliance

Billing Rule

Authorization, Documentation, and Billing Compliance — risk of denial or recoupment if not followed

Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis, and claims must use industry-standard, compliant codes (CPT, HCPCS, revenue codes) fully supported in the medical record; failure to follow billing or coding guidelines may result in claim rejection, denial, or recovery/recoupment. If an applicable assistant-at-surgery modifier is not billed appropriately, the procedure may be denied. Anthem applies the same multiple-procedure fee reductions and clinical edits to both the assistant and primary surgeon, and the assistant should not report procedure codes different from the primary surgeon except when the primary surgeon bills a global code (then the assistant bills the specific surgery code with the appropriate modifier).

Obtain/confirm any required prior authorization and ensure services meet medical necessity for the procedure and diagnosis.
Use correct industry-standard codes (CPT, HCPCS, revenue codes) and bill the appropriate assistant-at-surgery modifier (e.g., 80) on the claim.
Support all billed services and modifiers with documentation in the medical record and office notes to avoid denials or recoupment.
When multiple procedures are performed, expect fee reductions and edits to apply to both assistant and primary surgeon.
Do not report different procedure codes than the primary surgeon unless the primary billed a global code; then bill the specific surgery code with the appropriate modifier.

Modifier Definitions and Reimbursement Rules

Modifier 80

Modifier 80 — definitionDenotes an assistant at surgery providing full assistance to the primary surgeon.

Modifier 80 — reimbursementReimbursement is based on 16% of the allowable fee for the primary surgeon.

Billing noteIf an applicable modifier is not billed appropriately, the procedure may be denied.

Modifier 81

Modifier 81 — definitionDenotes an assistant at surgery providing minimal assistance to the primary surgeon.

Modifier 81 — reimbursementReimbursement is based on 10% of the allowable fee for the primary surgeon.

Coverage stanceAnthem does not allow reimbursement for Modifier 81 (see policy restrictions).

Modifier 82

Modifier 82 — definitionDenotes an assistant at surgery when a qualified resident surgeon is not available to assist the primary surgeon.

Modifier 82 — reimbursementReimbursement is based on 20% of the allowable fee for the primary surgeon.

Coverage stanceAnthem does not allow reimbursement for Modifier 82 (see policy restrictions).

Modifier AS

Modifier AS — definitionDenotes an assistant at surgery who is a non-physician (physician assistant, nurse practitioner, or clinical nurse specialist).

Modifier AS — reimbursementReimbursement is based on 20% of the allowable fee for the primary surgeon.

Coverage stanceAnthem does not allow reimbursement for Modifier AS (see policy restrictions).